title: First experience using navigation-guided radiofrequency kyphoplasty for sacroplasty in sacral insufficiency fractures.
abstract: OBJECTIVE
  To evaluate the efficacy and safety of navigation-guided radiofrequency kyphoplasty for sacroplasty in patients with sacral insufficiency fractures.
  
  
  METHODS
  In this single-center retrospective observational study, four consecutive patients with sacral insufficiency fractures were treated with navigation-guided radiofrequency kyphoplasty for sacroplasty between April 2010 and May 2012. Symptom characteristics, pain duration and pain intensity were recorded for each patient. Cement extravasation was evaluated in thin-sliced and triplanar reconstructed CT scans of the sacrum.
  
  
  RESULTS
  Four female patients with painful sacral insufficiency fractures and extensive osteopenic areas significantly improved from an average pre-treatment VAS score of 8.3 ± 0.5 to 2.3 ± 1.0 (p < 0.001) on the first postoperative day and to 1.3 ± 1.9 (p < 0.004) at follow-up (mean, 20.1 weeks). Slight cement extravasations were observed without evidence of being symptomatic. No major complications or procedure-related morbidity were noted.
  
  
  CONCLUSIONS
  From the limited experience in four patients, navigation-guided radiofrequency kyphoplasty appears to be a safe and effective treatment option for sacral insufficiency fractures even though asymptomatic cement extravasation was noted. The use of navigation based on intraoperative 3 D images simplifies the positioning of the navigated bone needles via the long axis approach. The radiofrequency kyphoplasty system provides the possibility to administer a sufficient amount of bone cement with a well-defined viscosity over the entire period of the procedure leading to high security and low cement extravasation. Sacroplasty provides rapid and enduring pain relief and facilitates prompt mobilization.
authors.affiliation: Department of Neurosurgery, Freiburg University Medical Center, Freiburg, Germany. jan-helge.klingler@uniklinikfreiburg.de
authors.forename: J-H
authors.initials: JH
authors.lastname: Klingler
authors.forename: P
authors.initials: P
authors.lastname: Kluge
authors.forename: R
authors.initials: R
authors.lastname: Sircar
authors.forename: E
authors.initials: E
authors.lastname: Kogias
authors.forename: C
authors.initials: C
authors.lastname: Scholz
authors.forename: M T
authors.initials: MT
authors.lastname: Krüger
authors.forename: C
authors.initials: C
authors.lastname: Scheiwe
authors.forename: U
authors.initials: U
authors.lastname: Hubbe
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005119:Extravasation of Diagnostic and Therapeutic Materials / Q000000981:diagnostic imaging; D005260:Female; D005471:Fluoroscopy / Q000379:methods; D006801:Humans; D007090:Image Interpretation, Computer-Assisted / Q000379:methods*; D007091:Image Processing, Computer-Assisted; D021621:Imaging, Three-Dimensional / Q000379:methods*; D058498:Kyphoplasty / Q000379:methods*; D008875:Middle Aged; D058866:Osteoporotic Fractures / Q000000981:diagnostic imaging* / Q000601:surgery*; D010147:Pain Measurement; D012189:Retrospective Studies; D012447:Sacrum / Q000000981:diagnostic imaging* / Q000293:injuries / Q000601:surgery*; D016103:Spinal Fractures / Q000000981:diagnostic imaging* / Q000601:surgery*; D025321:Surgery, Computer-Assisted / Q000379:methods*; D014057:Tomography, X-Ray Computed / Q000379:methods*